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A new algorithm for the compression and real-time digital transmission of ECG data over normal telephone lines has been developed and tested. The technique combines modified adaptive delta modulation and second difference with Huffman coding. The compression for the methods was 91.67% and 73.7% respectively, averaging 82.6%. A high compression ration with good quality signal reproduction was achieved. This method is suitable for digital ECG transmission over standard telephone networks in real time. Compressed 12-lead ECG data are sent to a central processing unit via telephone line, using a 1200-baud modem with a personal computer. The reconstructed ECG is interpreted by an ECG computer analysis program at the Veterans General Hospital (VGH). The computer reports are compared with a physician's diagnosis.